超声误诊颈外静脉血管瘤为假性静脉瘤1例

正患者女,46岁。因"发现右侧颈部包块进行性增大2+年"入院,查体:右侧颈部可扪及一大小约2cm×3cm椭圆形包块,质软,压痛阳性,表面光滑,境界清楚,活动度尚可,与周围无明显粘连,乏氏运动后可见增大(图1)。超声显示:右侧颈外静脉汇入段可见一大小约1.8cm×0.8cm的囊袋状无回声区,与颈外静脉相通,通道口内径约0.5cm,     

超声诊断女婴子宫卵巢疝入腹股沟1例

<正>患儿女,42d。反复哭闹1d,因发现右侧腹股沟包块8h就诊。体格检查:发育良好,腹平软,无压痛、反跳痛,肝脾肋下未触及,全腹部未扪及包块,右侧腹股沟触及一大小约3.6cm×1.3cm×2.7cm的包块,与周围组织无明显粘连,无压痛,局部     

子宫圆韧带转移性黏液腺癌超声表现1例

<正>患者女,60岁,因右侧腹股沟区包块3个月入院。体格检查:右腹股沟区有一大小约5 cm×5 cm的半圆形包块,不能还纳,质硬,与周围组织界限不清,活动度差,无明显红、肿、热、痛等,包块外下方另可扪及大小约1 cm×1 cm的硬结,边界不清,活动度差。超声所见:右侧腹股沟区可见大小约7.0 cm×4.2 cm的类圆形无回声,前方囊壁可见不均匀增厚呈低回声,最厚处约     

播散性腹膜平滑肌瘤病超声表现1例

正患者女,42岁,因"左下腹胀痛及发现盆腔包块7 d"就诊。自诉20年前因"子宫多发肌瘤"于外院行全子宫、右侧附件及左侧输卵管切除手术。体格检查:腹壁左右不对称,左腹明显高于右腹,左腹可扪及一大小约25.0 cm×15.0 cm×10.0 cm实性包块,无压痛,位置固定无活动,其最高点位于左侧脐旁;左附件区另可扪及一大小约7.5 cm×5.0 cm实性包块,位置固定,与盆腔左侧壁关系密切;右附件区可扪及一大小约8.0 cm×4.0 cm实性包块,轻压痛,与盆腔前壁关系密切。超声检查:腹盆腔见多个     

软组织颗粒细胞瘤类似恶性超声表现1例

<正>患者女,57岁。发现右侧腹股沟区包块就诊。查体:耻骨联合右侧皮下可扪及一大小约2cm×2cm×2cm的肿物,形态不规则,与周围分界不清,质韧,无压痛,表面皮肤无红肿。彩超检查:耻骨联合右侧皮下脂肪层内可探及一大小约1.8cm×1.5cm×2.0cm的实性低回声结节,边界欠清晰,轮廓不规整,边缘呈毛刺状,内回声欠均质,后方回声衰     

乳腺错构瘤超声表现1例

<正>患者女,26岁,因无意中发现右乳包块入院。体格检查:右侧乳腺1点钟距乳头约5.0 cm处可扪及一个大小约3.0 cm×1.5 cm包块,质韧,无压痛,与周围组织无粘连,无胸壁固定。超声检查:右侧乳腺1点钟距乳头约5.5cm处脂肪层内可见一个大小约2.6cm×1.3 cm的稍高回声包块,边界欠清楚,边缘欠规则,内部回声不均质,CDFI示其内探及彩色血流信号(图1)。超声     

高频超声诊断腰部疝1例

患者男,67岁.主诉:咳嗽伴右侧腰部可复性包块半年.查体:右侧腰部于立位可扪及一包块,质软.包块约4 cm × 3 cm.于卧位时扪之不清.使用仪器:SIEMENS ×300,探头频率:14.0 MHz.超声显示:右侧腰部于坐立位时扫查,见筋膜层下一大小约3 cm × 3 cm × 2 cm的囊性包块,边界欠清晰,囊内见斑状和点状回声,深面与腹腔相通,通道口处约1.2 cm.探头加压包块,可见内容物从通道口处流入腹腔(图1).     

超声诊断小儿右侧睾丸横过异位并左侧腹股沟斜疝1例

患儿男,1岁零4个月9天,因阴囊右侧空虚1年,左侧腹股沟包块半年入院。体格检查：阴囊右侧空虚,阴囊内及右侧腹股沟区均未扪及肇丸;左侧腹股沟区扪及一大小约7cm×4cm的梨形包块,质软,无压痛,     

盆腔腹膜后孤立性纤维瘤经直肠超声表现1例

<正>患者女,24岁,2+个月前于健康体检时发现右侧附件区包块,超声提示右附件区一大小约4.3 cm×4.7 cm×4.7 cm的椭圆形实质样低回声包块,未治疗;2 d前超声复查无变化,妇科检查于右侧附件区可扪及一直径约4 cm肿块,活动度好,质硬。术前初步诊断:1右侧卵巢肿瘤;2宫颈肌瘤。行腹腔镜探查时发现双侧卵巢显示良好,盆腔未见明确包块;肛门指诊于直肠右侧7~11点位置可扪及直径约6 cm包块,光滑,不活动,考虑腹膜     

超声诊断右侧睾丸横过异位1例

患者男,30岁,因左腹股沟区可反复性包块5年,不能回纳4h来我院就诊。体格检查:左侧腹股沟区扪及一大小约6cm×3cm×2cm的包块,部分进入阴囊,不能回纳,患处轻压痛,左侧阴囊内可扪及睾丸;右侧阴囊内和右侧腹股沟区均未扪及睾丸。彩色多普勒超声检查:右侧阴囊内未探及睾丸回声,左侧阴囊内探及睾丸回声,形态大小正常。左侧腹股沟区探及低     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.